© 2017 Family Law Self-Help Center Consent to Child’s Name Change (Parent)
* You are responsible for knowing the law about your case. For more information on the law, this form, and free
classes, visit www.familylawselfhelpcenter.org or the Family Law Self Help Center at 601 N. Pecos Road. To find
an attorney, call the State Bar of Nevada at (702) 382-0504.
1
CONS
Your Name: ________________________
Address: ___________________________
City, State, Zip: _____________________
Phone: ____________________________
Email: ____________________________
Self-Represented Petitioner
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Application of:
(1
st
adult) ________________________________
And
(2
nd
adult) ________________________________
write “n/a” above if only 1 adult.
For Change of Name for Themselves and for the
Minor Children:
(1
st
child’s name) ___________________________
And
(2
nd
child’s name) __________________________
CASE NO.: ____________________
DEPT: _____________________
CONSENT TO NAME CHANGE (PARENT)
I, (consenting parent’s name) __________________________________________, am the (
check one) mother / father of the above-named minor child(ren), and I give my full and free
consent to change the name of my minor child from (clearly print the first child’s current legal
name)
_____________________ ______________________ _______________________
(first) (middle) (last)
to: (clearly print the first child’s new name requested)
_____________________ ______________________ _______________________
(first) (middle) (last)
THIS FORM MUST BE SIGNED IN FRONT OF A NOTARY.
Once you complete the form, print it out and sign it in front of a notary. The parent's original signature and the
notary's stamp and signature must appear on the document that is filed with the court.
